Arterial and anastomotic wrapping in pancreaticoduodenectomy as a strategy to reduce complications: a systematic review and meta-analysis

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-05-01 DOI:10.1016/j.hpb.2025.02.001

Gabriele E. Lech , Patrícia Viana , Camila M. de Paiva Reis , Ana P. Valério-Alves , João L.R. Freitas , Raquel O. de Sousa Silva , Rafael Morriello

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引用次数: 0

Abstract

Background

Pancreaticoduodenectomy is associated with high morbidity, with pancreatic fistulas and hemorrhages being the most dangerous complications. We performed a systematic review and meta-analysis to evaluate the efficacy of arterial and anastomotic wrapping in pancreaticoduodenectomy.

Methods

We searched PubMed, Embase, and Cochrane Central from inception to February 2024 for studies comparing omental or ligament flaps for arterial or pancreaticojejunostomy coverage in pancreaticoduodenectomies, evaluating common postoperative complications. Odds ratio (OR) was used for categorical variables and mean difference (MD) for continuous variables. We considered as significant p-values < 0.05.

Results

We included 15 studies, comprising 3232 patients. The intervention successfully reduced the rates of postpancreatectomy hemorrhage (OR 0.47; p < 0.001), with an additional reduction in postoperative pancreatic fistula when considering the use of omental wrapping (OR 0.48; p = 0.002). Delayed gastric emptying was not associated with a reduction when using the wrapping technique (OR 0.69; p = 0.06).

Conclusion

Our findings showed that the wrapping technique decreased the rate of major complications associated with pancreaticoduodenectomy without increasing operative time or reoperation rates.

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胰十二指肠切除术中动脉和吻合口包裹术作为减少并发症的策略：系统回顾和荟萃分析

背景胰十二指肠切除术发病率高，胰瘘和出血是最危险的并发症。我们进行了系统回顾和荟萃分析，以评估动脉和吻合口包裹术在胰十二指肠切除术中的疗效。方法我们检索PubMed， Embase和Cochrane Central从成立到2024年2月的研究，比较网膜或韧带皮瓣在胰十二指肠切除术中动脉或胰空肠吻合术的覆盖范围，评估常见的术后并发症。分类变量采用比值比（OR），连续变量采用均差（MD）。我们认为显著p值<；0.05.结果纳入15项研究，包括3232例患者。干预成功地降低了胰腺切除术后出血的发生率(OR 0.47；p & lt;0.001)，考虑使用网膜包裹术时，术后胰瘘发生率进一步降低(OR 0.48；p = 0.002)。使用包裹技术时，胃排空延迟与减少无关(OR 0.69；p = 0.06)。结论胰十二指肠切除术采用包绕技术可降低主要并发症的发生率，且不增加手术时间和再手术率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).